M Bruguera

Colegio Oficial de Médicos de Valencia, Valenza, Valencia, Spain

Are you M Bruguera?

Claim your profile

Publications (379)1778.9 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Significant liver fibrosis (F⩾2) and portal hypertension (hepatic venous pressure gradient [HVPG] ⩾6mmHg) 1 year after liver transplantation (LT) are predictors of severe hepatitis C recurrence. Periportal sinusoidal fibrosis (SF) is an early expression of the fibrogenic process in response to liver injury. We aimed to evaluate whether SF in early liver biopsies represents an early and accurate marker for identifying patients with severe HCV recurrence after LT. A total of 101 HCV LT patients with early biopsy (<6 months), and HVPG measurement and/or liver biopsy one year after LT were included. Early biopsies were stained with Sirius Red and SF was graded semi-quantitatively. Results were compared between groups (significant SF vs. non-significant SF) and correlated with the development of severe HCV recurrence one year after LT. Patients with early significant SF had older donor age and higher necroinflammatory activity (NIA). The presence of early significant SF enabled identification of 78.9% and 90.6% of patients with F⩾2 and HVPG⩾6 mmHg, respectively, one year after LT. Donor age and NIA were independent predictors of significant fibrosis (F⩾2) one year after LT, whereas donor age, ALT (3 months), NIA, and SF grade were independent predictors of portal hypertension (HVPG⩾6). Significant SF in early biopsies is a good predictor of severe hepatitis C recurrence. This histological finding, when combined with simple variables, may be useful to select the best candidates for early antiviral therapy after LT.
    Journal of Hepatology 04/2014; · 9.86 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Antecedentes y objetivo Los premios a la excelencia del Colegio Oficial de Médicos de Barcelona (COMB) fueron instituidos en 2004 para reconocer la excelencia en el ejercicio profesional. Los premiados son elegidos anualmente por jurados nombrados por la junta de gobierno, cuyos miembros proponen médicos que en su opinión tienen un comportamiento profesional y humano ejemplar. Sujetos y métodos Hemos analizado el número de médicos y médicas que han obtenido este reconocimiento y la relación entre el número de varones y mujeres premiados con la distribución por géneros en los jurados. Asimismo se han comparado las edades de médicos y médicas premiados y la de colegiados y colegiadas de más de 45 años. Resultados La relación de varones y mujeres entre los premiados fue de 2,7/1 (rango: 1,2/1 para los premiados en Atención Primaria y 6/1 en el apartado Investigación), con una correlación directa no estadísticamente significativa entre la relación varones/mujeres premiados y jurados. La relación entre varones y mujeres colegiados con más de 45 años fue de 1,4/1, mientras que en los premiados fue de 2,7/1. En los últimos 4 años ha incrementado la proporción de mujeres en los jurados y de forma paralela ha aumentado el número de médicas premiadas. Conclusión El predomino de varones entre los premiados parece relacionarse con la mayor proporción de varones en la composición de los jurados.
    Revista Clínica Española (English Edition). 03/2014; 214(2):69–73.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: There is no histologic classification system to determine prognoses of patients with alcoholic hepatitis (AH). We identified histologic features associated with disease severity and created a histologic scoring system to predict short-term (90 day) mortality. We analyzed data from 121 patients admitted to the Liver Unit (Hospital Clinic, Barcelona, Spain) from January 2000 through January 2008 with features of AH, and developed a histologic scoring system to determine risk of death using logistic regression. The system was tested and updated in a test set of 96 patients from 5 academic centers in the US and Europe, and a semi-quantitative scoring system was developed, called the alcoholic hepatitis histologic score (AHHS). The system was validated in an independent set of 109 patients. Inter-observer agreement was evaluated by weighted κ statistic analysis. Degree of fibrosis, neutrophil infiltration, type of bilirubinostasis, and presence mega-mitochondria were independently associated with 90 day mortality. We used these 4 parameters to develop the AHHS to identify patients with low (0-3 points), moderate (4-5 points), and high (6-9 points) risks of death within 90 days (3%, 19%, and 51%, respectively; P<.0001). The AHHS estimated 90 day mortality in the training and test sets with an area under the receiver operating characteristic value of 0.77 (95% confidence interval, 0.71-0.83). Inter-rate agreement values were 0.65 for fibrosis, 0.86 for bilirubinostasis, 0.60 for neutrophil infiltration, and 0.46 for megamitochondria. Interestingly, the type of bilirubinostasis predicted the development of bacterial infections. We identified histologic features associated with severity of AH and developed a patient classification system that might be used in clinical decision making.
    Gastroenterology 01/2014; · 12.82 Impact Factor
  • Medicina Clínica 12/2013; · 1.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The awards for the excellence of the Official College of Physicians of Barcelona (COMB) were instituted in 2004 to recognize the excellence of the professional exercise. The winners are yearly chosen by juries appointed by the board of government, whose members propose for the award doctors who, in their opinion, have an exemplary professional and human behaviour. The number of male and female doctors who have obtained this recognition has been analysed in relation with the sex distribution in the juries. Likewise it has been compared the ratios men-to-women of those who have been rewarded and this ratio among physicians of more than 45 years. Between the awarded physicians the ratio men-to-women was of 2.7/1 (range, from 1.2/1 for awardees in primary care to 6/1 in research). The men-to-women ratio among those who were awarded was in parallel to the man-to-women ratios of the juries. The ratio between men and women among members of the COMB of more than 45 years was 1.4/1, whereas in those who were awarded it was of 2.7/1. The increase in the proportion of women in the juries in the last four years has been followed by an increase in the number of female physicians awarded. This data demonstrates that the predominance of male doctors among those who were awarded does not depend so much on the age factor, but basically on the proportion of male and female doctors in the juries.
    Revista Clínica Española 11/2013; · 2.01 Impact Factor
  • Gastroenterología y Hepatología 10/2013; · 0.57 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background To study an outbreak of media news related to nosocomialinfections due to opportunistic fungi in Spanish hospitals. Method Case definition: any news related to possible nosocomial infectiondue to opportunistic fungi in Spanish hospitals, published innational or local daily newspapers, over the pre-epidemic (July-December,1998) and epidemic periods (January-June, 1999). All newswere reviewed and identified using global press reports summaries,prepared by two independent sources, and were analyzed by three differentobservers. Results Over the pre-epidemic period there were not any news relatedto nosocomial infections due to opportunistic fungi. Over the epidemicperiod, a total of 218 news were identified, 154 (71%) publishedin national newspapers and 64 (29%) in local ones. We analyzedseparately 18 editorials or opinion articles related to this subject.The epidemic curve (distribution of news by week) showed an incidence news peak at week 5 (102 news, 46.7% of all news published).The media mentioned up to 19 different hospitals as institutionswith possible cases of nosocomial fungal infections. After week8, news incidence drop, and remain thereafter at minimum levels. Conclusions The example provided by the analysis of this outbreak ofmedia news, related to nosocomial infections by Aspergillus an otheropportunistic fungi, is useful to allow us understand how some medicalnews arise, develop and were transmitted. The public alert situationcreated in Spain was remarkable, and it is likely that there was atransient loss of confidence in the safety of public health institutions.Today's medicine requieres a great and better openness to the media,and a better cooperation between both parts.
    Medicina Clínica. 07/2013; 114(7):259–263.
  • Miquel Bruguera
    Gastroenterología y Hepatología 06/2013; · 0.57 Impact Factor
  • Medicina Clínica. 01/2013;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Precedents and aim The awards for the excellence of the Official College of Physicians of Barcelona (COMB) were instituted in 2004 to recognize the excellence of the professional exercise. The winners are yearly chosen by juries appointed by the board of government, whose members propose for the award doctors who, in their opinion, have an exemplary professional and human behaviour. Subjects and methods The number of male and female doctors who have obtained this recognition has been analysed in relation with the sex distribution in the juries. Likewise it has been compared the ratios men-to-women of those who have been rewarded and this ratio among physicians of more than 45 years. Results Between the awarded physicians the ratio men-to-women was of 2.7/1 (range, from 1.2/1 for awardees in primary care to 6/1 in research). The men-to-women ratio among those who were awarded was in parallel to the man-to-women ratios of the juries. The ratio between men and women among members of the COMB of more than 45 years was 1.4/1, whereas in those who were awarded it was of 2.7/1. The increase in the proportion of women in the juries in the last four years has been followed by an increase in the number of female physicians awarded. Conclusion This data demonstrates that the predominance of male doctors among those who were awarded does not depend so much on the age factor, but basically on the proportion of male and female doctors in the juries.
    Revista Clínica Española 01/2013; · 2.01 Impact Factor
  • Gastroenterología y Hepatología. 01/2013;
  • Source
    M. Bruguera
    Revista Clínica Española 06/2012; 212(6):311–316. · 2.01 Impact Factor
  • M Bruguera
    Revista Clínica Española 06/2012; 212(6):311-6. · 2.01 Impact Factor
  • Gastroenterología y Hepatología 05/2012; · 0.57 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Claims due to presumed medical malpractice are increasing in all developed countries and many of them have no basis. To prevent legal complaints, the physicians should know the reasons why complaints are made by their patients and adopt the adequate preventive measures. In the case of a complaint, it is essential to follow the guidelines that allow for adequate legal defense and the action of the physician before the judge that inspires confidence and credibility.The risk of the claims can be reduced with adequate information to the patient, the following of the clinical guidelines, control of the risk factors and adoption of verification lists in each invasive procedure.In case of complication or serious adverse effect, explanations should be given to the patient and family and it should be reported to the facility where one works and to the insurance company.If the physician received a claim, he/she should report it to the insurance compare so that it can name a lawyer responsible for the legal defense who will advise the physician regarding the appearance in court before the judge.
    Revista Clínica Española 04/2012; 212(4):198–205. · 2.01 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To analyse the causes for claims due to alleged malpractice in bariatric surgery and the results of the legal process. A review was carried out on the case files of claims for damages as a result of bariatric surgery presented to the Professional Liability Department of the Catalonian Medical Colleges Council from 1992 to 2009. The claims rate was calculated using a survey of bariatric surgeons. A total of 49 cases were analysed, which represented 0.6% of the patients operated on. The patient died in 23 (47%) of the cases, 14% were left with serious after effects, 18% had mild after effects, and 21% made a complete recovery. The most frequent causes of death were peritonitis due to suture dehiscence (48%), and respiratory complications (17.4%). Retrospectively, malpractice was considered to have occurred in 10 (20%) of the sued cases due to lack of an adequate informed consent document, delay in recognising a complication, or an error in interpretation, or treatment of the complication. The doctor sued was convicted in 10 of the cases, 3 in a criminal court, and 7 in a civil court. There was acquittal in 19 cases, an out-of court settlement with payment of compensation in 4, withdrawal of the claim in 4, and judgement or sentence is still pending in 12 cases. The study showed a relatively low rate of claims for complications associated with bariatric surgery. The number of convictions was relatively high. The early detection of surgical complications is essential in order to reduce legal claims associated with bariatric surgery.
    Cirugía Española 03/2012; 90(4):254-9. · 0.87 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Claims due to presumed medical malpractice are increasing in all developed countries and many of them have no basis. To prevent legal complaints, the physicians should know the reasons why complaints are made by their patients and adopt the adequate preventive measures. In the case of a complaint, it is essential to follow the guidelines that allow for adequate legal defense and the action of the physician before the judge that inspires confidence and credibility. The risk of the claims can be reduced with adequate information to the patient, the following of the clinical guidelines, control of the risk factors and adoption of verification lists in each invasive procedure. In case of complication or serious adverse effect, explanations should be given to the patient and family and it should be reported to the facility where one works and to the insurance company. If the physician received a claim, he/she should report it to the insurance compare so that it can name a lawyer responsible for the legal defense who will advise the physician regarding the appearance in court before the judge.
    Revista Clínica Española 03/2012; 212(4):198-205. · 2.01 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In idiopathic portal hypertension (IPH) typical vascular lesions are present in the branches of the portal vein or in the perisinusoidal area of the liver. Similar histological alterations have been reported in the pulmonary vasculature of patients with idiopathic pulmonary artery hypertension (IPAH). As IPAH is associated with mutations of the bone morphogenetic protein receptor 2 (BMPR2) gene, the aim of this study was to investigate whether this association might also be found in patients with IPH. Twenty-three samples belonging to 21 unrelated caucasian patients with IPH followed in the hepatic haemodynamic laboratory of the Hospital Clinic in Barcelona were included in the study. All patients were studied for the entire open reading frame and splice site of the BMPR2 gene by direct sequencing and multiple ligation probe amplification (MLPA) in order to detect large deletions/duplications. None of the 23 patients had pulmonary artery hypertension. Four patients presented one single nucleotide polymorphism (SNP) in intron 5, four patients had a SNP in exon 12 and a SNP in exon 1 was found in two cases. Two patients had both intron 5 and exon 12 polymorphisms. All SNPs were previously described. Except for these three SNPs, neither mutations nor rearrangements have been identified in the BMPR2 gene in this population. We did not detect mutations or rearrangements in the coding region of the BMPR2 gene in our patients with IPH. These findings suggest that, in contrast to IPAH, mutations in BMPR2 are not involved in the pathogenesis of IPH.
    Journal of Cellular and Molecular Medicine 12/2011; 16(9):2017-21. · 4.75 Impact Factor
  • Hepatology 10/2011; 54(1):1207A. · 12.00 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We reviewed the records of patients filing alleged malpractice claims related to gastrointestinal endoscopy to the Professional Responsibility Section of the Medical Council of Catalonia from 1987 to 2009 to determine the frequency of medical errors or substandard care in the practice of this procedure and the result of complaints according to whether malpractice might have been involved or not. There were a total of 66 complaints, 46 (70%) after colonoscopy, 12 (18%) after endoscopic retrograde cholangiography and eight (12%) after gastroscopy. In 18 (27%) cases, we considered malpractice to have been probable, due to lack of informed consent in four, delayed treatment of complications in six, substandard sedation in five, misdiagnosis in two and substandard practice in one, which would justify the complaints. Of the 48 cases we considered not to have involved malpractice, a guilty verdict was secured in one and an out-of-court settlement was reached in six with regard to the disproportionate and permanent harm experienced by the patients. Among the 66 claims, an out-of-court settlement was reached with the complainant on 19 occasions (28.7%) and a civil or penal trial was held in 39 (59%), resulting in a guilty verdict in only 10% of cases. In eight cases (15.3%), the complainant took no further action after receiving the response of the Professional Responsibility Section. The number of complaints progressively increased over the study period. There were a greater number of complaints in private clinics than in public hospitals. Endoscopists with more than one complaint were more frequently found guilty or reached an out-of-court settlement than those with only one complaint against them (100% versus 28%). Analysis of complaints of alleged malpractice is useful to identify areas requiring improved patients safety and to reduce the number of these complaints.
    Gastroenterología y Hepatología 03/2011; 34(4):248-53. · 0.57 Impact Factor

Publication Stats

6k Citations
1,778.90 Total Impact Points

Institutions

  • 2013–2014
    • Colegio Oficial de Médicos de Valencia
      Valenza, Valencia, Spain
  • 1999–2014
    • IDIBAPS August Pi i Sunyer Biomedical Research Institute
      Barcino, Catalonia, Spain
    • University Hospital Vall d'Hebron
      • Department of Preventive Medicine and Epidemiology
      Barcino, Catalonia, Spain
  • 1987–2013
    • Hospital Clínic de Barcelona
      • • Servicio de Hepatología
      • • Servicio de Hematología
      • • Servicio de Medicina Preventiva y Epidemiología
      Barcelona, Catalonia, Spain
  • 1971–2013
    • University of Barcelona
      • Department of Medicine
      Barcino, Catalonia, Spain
  • 2012
    • Collegi Oficial de Metges de Barcelona
      Barcino, Catalonia, Spain
  • 2007
    • Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas
      Barcino, Catalonia, Spain
  • 2004
    • Hospital Universitario Nuestra Señora de Valme
      Hispalis, Andalusia, Spain
    • Southern Medical Clinic
      San Fernando, City of San Fernando, Trinidad and Tobago
  • 2002
    • Hospital Universitari Germans Trias i Pujol
      Badalona, Catalonia, Spain
  • 1997
    • Autonomous University of Barcelona
      Cerdanyola del Vallès, Catalonia, Spain
  • 1994–1996
    • Parc de Salut Mar
      Barcino, Catalonia, Spain
  • 1989
    • Hospital Clínico, Maracaibo
      Maracaibo, Estado Zulia, Venezuela